2012-01-09_REPORT - M2000115

• Permit No: M2000115
• IBM Index Class Name: REPORT
• Doc Date: 1/9/2012
• From: Mullett Excavating, LLC
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Email Name: SJR
• Email Name: SJM
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
Permittce Contact: Myron Mullett Myron Mullett
Petmittec Name:
Address:
Phone Number:
Fax Number:
Signature
-
batc
ANI'UAL FEE and R)EPO1.T REQUEST
{I` Mullett Excavating, LLC
M- 2000 -115
Mulletts Excavating Pit # 1
January 29, 2012
$ 791.00 (Due on or before your anniversary date)
Las Animas
RECEIVE,
JAN 0 '4
-, Division of Reclamation,
Mining & Sofety
According to C.R.S. 34- 32.5 -116 or C.R.S. 34 -32 -116, each year on the anniversary date of the permit, an operator
shall submit the annual fee, a report and map showing the extent of current disturbances to affected land. reclamation
accomplished to date and during the preceding year, new disturhanccs that are anticipated to occur during the
upcoming year, reclamation that will be performed during the coming year, the dates for the beginning of active
operations. and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual report map to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
map. If no new disturbances or reclamation have occurred during the previous year and no new changes to
the previous year's map are necessary then no new map is required provided that the Operator shall state
this in the Annual Report. Please note that an adequately labeled nzap that clearly delineates and includes the
above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Mullett Excavating, LLC
P.O. Box 322
Wcstcliffc, CO 81252
[phone]
(719) 783 -0156
If you have additional comments and /or information that should be provided to the Division. please provide it
below or attach it to this torn along with your writtcn report and map. Annual Report instructions are enclosed.
rporate Officer Owner or Designee